There Are Four Lights

Alternative medicine is a major public health risk. Untested and discredited treatments are promoted for just about any health problem you can imagine. Those who are most desperate are often the target of alt-med treatments, swooping in to provide an “alternative” or “complimentary” cure when real medicine, unfortunately, has been unsuccessful. There is one area, however, where the quack alternative treatment has established itself as the standard treatment: 12-step programs in the area of addiction.

Alcoholics Anonymous is the original 12 Step program, which has spawn a whole industry of recovery programs that basically copy-paste the 12 steps to deal with any addictive behaviour—-Narcotics Anonymous, Overeaters Anonymous, Workaholics Anonymous, Clutterers Anonymous, Sex and Love Addicts Anonymous, Online Gamers Anonymous, Smokers Anonymous, Emotions Anonymous—-the list goes on. There are also groups like Al-anon, where you don’t have to be an addict yourself, only someone being affected by one.

AA has been extremely successful in promoting itself as the most successful treatment for alcoholism. It markets itself as a non-denominational support group for alcohol abuse. Once inside the walls of its meetings, however, it’s clear that members are to understand that AA is the only treatment for alcoholism. It isn’t officially stated (in fact, the opening remarks are careful to say that the program is “widely regarded” as the most successful treatment), but if it isn’t implied in nearly every member’s ‘share’—-their anecdotal evidence that life without AA means relapse and death—-it is certainly the message of the AA bible “Alcoholics Anonymous”, referred to as The Big Book.

What is often said in the meetings and what is written in The Big Book contradict the public image of AA as a support group for those who wish to quite drinking. What the general public doesn’t know about AA is that it is a religious group which teaches its members that alcoholism is a spiritual disease with no cure and only by giving yourself up to God can one stay sober.

“Unless each A.A. member follows to the best of his ability our suggested Twelve Steps to recovery, he almost certainly signs his own death warrant.”
Twelve Steps and Twelve Traditions, William G. Wilson, page 174.

Though it is argued that the Twelve Steps refer to a “power great than ourselves” and that ‘power’ can be anything you want, it is clear in the reading material that you are supposed to want that power to be God.

We found that as soon as we were able to lay aside prejudice and express even a willingness to believe in a Power greater than ourselves, we commenced to get results, even though it was impossible for any of us to fully define or comprehend that Power, which is God.
The Big Book, 3rd & 4th Editions, William G. Wilson, Page 46.

It is also clear that the goal of AA isn’t to stop abusing alcohol, but to serve God.

“At the moment we are trying to put our lives in order. But this is not an end in itself. Our real purpose is to fit ourselves to be of maximum service to God…”
The Big Book, William G. Wilson, page 77.

(My bold)

The magical thinking in AA is no different than that found in other alternative medicine. Like any typical spiritual healer, who will tell you that ‘negative energy’ is the cause of your cancer, AA attributes alcoholism to sins and moral shortcomings instead of alcohol consumption. In AA, being sober doesn’t mean simply not drinking. You are only sober if you have turned your will over to a power greater than yourself. Those who haven’t done this are labelled “dry drunks”. When their quack treatments don’t work, alternative medicine proponents will blame the patient. In the world of AA, if you overcome your addiction without the program (especially if you learn to drink in moderation), you were never an alcoholic in the first place.

But the most important feature of AA, true of any other alternative medicine, is that it doesn’t work. Those of us who advocate science based medicine make evidence of efficacy a requirement. The 12 Step industry deserves the same skepticism that we would apply to any other faith healing group…and people suffering from substance abuse and addiction deserve more than the “support” of a spiritual cult.

How much do you know about Alcoholics Anonymous and other 12 Step programs? It’s a support group, right? It’s safe to say it’s widely regarded as the most successful recovery program for addiction. Then again, accupuncture is widely regarded as a successful treatment for all kinds of illnesses but anyone familiar with science-based medicine knows it simply doesn’t work. So, why should 12 Step programs be treated with any less skepticism? After all, AA makes claims regarding the causes of and treatments for alcoholism. What evidence, if any, is there to support these claims?

“Undrunk: A Skeptic’s Guide to AA”, by A.J. Adams, seems anything but skeptical. That is, the word ‘skeptic’ seems to be used in the “I was skeptical, at first” kind of way…rather than referring to a person who evaluates claims based on evidence and the scientific method. Has AA escaped the attention of the science and skepticism community? Certainly, the 12 Step industry must be one of the most successful quackery organizations out there–embedding themselves into the medical industry as successfully as any alternative medicine woo–and branding themselves as secular more successfully than intelligent designers.

AA and its counterparts (there’s a 12 step program for just about any addiction) are anything but secular. Of course, any program member will tell you that atheists and agnostics are welcome…but the program is chuck-full of religion; only about four of the twelves steps make no use of god or spirituality. Dr. Harriet Hall wrote a great article over at Science-Based Medicine about AA and the lack of evidence for it’s effectiveness: AA is Faith-Based, Not Evidence-Based. Another resource I found is a blog called Stinkin Thinkin:

…[W]hat we’re doing is muckraking, in the time-honored sense of the word. AA and 12-Step is has a monopoly. Sure there are some alternatives, but none of these alternatives are offered in your general addictions treatment facility. And none of these alternatives have the power to lobby in Washington the way that AA does…to get insurance money

There is a group called SOS (Secular Organizations for Sobriety, or Save Our Selves) which provides non-religious support for alcoholism and drug addiction. I found some interesting articles about AA by browsing their site:

AA, as a doctor once told me, is “an evangelical movement about saving souls”. At its core it has a good heart – it wants to save people from their demons. But, as with the death penalty, McCarthyism, the Conquistadors and other such crusades against evil, the pious ambitions of AA make the movement blind to its own hooliganism. As disinterested in individuality as the SS, and unaccountable for its actions as the KKK, AA preaches, bullies and lies to achieve its ends, and it does so with all the righteous impunity of a secret sect. Unlike other religious cults, however, AA’s victims are those who escape from its grip and return to society, their brains so laundered by fundamentalist claptrap that a glass of beer can take on the menace of a loaded pistol. That I eluded such a fate myself is thanks to nothing but sheer good luck – those not as fortunate as I can’t tell us about it, their stools at the bars and chairs in AA inhabited by new people entirely disinterested in tales of the dead ones who went before them.

I know there’s a lot of woo for skeptics to deal with, but I think the 12 Step industry deserves more criticism from the skeptical community. AA isn’t an effective treatment, never mind the most effective treatment for alcoholism, and those suffering due to substance abuse deserve treatments which are evaluated for their safety and efficacy.